Jha Chandan Kumar, Johri Goonj, Singh Prashant Kumar, Yadav Sanjay Kumar, Sinha Upasna
Department of General Surgery, All India Institute of Medical Sciences, Patna, India.
Wythenshawe Hospital and Nightingale Breast Center, Manchester University Foundation Trust, Raebareli, India.
Indian J Surg Oncol. 2021 Sep;12(3):624-631. doi: 10.1007/s13193-021-01393-7. Epub 2021 Aug 3.
Patients with breast cancer are increasingly being offered breast conserving surgery (BCS) following neoadjuvant chemotherapy (NACT). We aimed to conduct a systematic review to assess the advantage of tumor marking in patients undergoing BCS after NACT. After registering the protocol for a systematic review with PROSPERO, a systematic search was conducted through September 30, 2020, for all studies involving patients undergoing BCS post NACT after tumor marking. Margin status on final histology was the primary outcome. Oxford Centre for Evidence Based Medicine (OCEBM) levels were used to assess internal validity. A total of 636 records from Medline/PubMed, 1381 from Embase, and 1422 from Cochrane library were extracted. After screening, 15 articles (1520 patients) were included for data synthesis. For marking, 6 studies used metallic markers and 5 used I-radioactive seeds (RSL) followed by skin tattoo and radio-guided occult lesion localization using Tc (ROLL) in one study each. Most studies used a single marker at the center except for two (143 patients), who practiced the bracketing technique. Incidence of unsatisfactory margins (positive/close) ranged from 5 to 23.5%. After excluding patients with complete pathological response, the "adjusted unsatisfactory margin" rate was found to be 19.3% (10.4-33%). Overall 20.6 recurrences (locoregional/distant) were reported per 1000 patient-years follow-up. Overall survival (OS) was only reported by one study as 96.6% and 84.7% in patients with and without marker placement ( = .01). Re-excision and secondary mastectomy rates (reported by nine studies) were 7.3% and 5.7% respectively. There is limited evidence that tumor marking before neoadjuvant chemotherapy improves the rate of unsatisfactory margins or survival outcomes in a patient undergoing BCS after NACT.
新辅助化疗（NACT）后，越来越多的乳腺癌患者接受保乳手术（BCS）。我们旨在进行一项系统评价，以评估肿瘤标记物在接受NACT后行BCS患者中的优势。在向PROSPERO注册系统评价方案后，截至2020年9月30日进行了系统检索，纳入所有涉及肿瘤标记后接受NACT后行BCS患者的研究。最终组织学切缘状态是主要结局。采用牛津循证医学中心（OCEBM）分级来评估内部效度。从Medline/PubMed提取了636条记录，从Embase提取了1381条记录，从Cochrane图书馆提取了1422条记录。筛选后，纳入15篇文章（1520例患者）进行数据合成。标记方面，6项研究使用金属标记物，5项使用碘放射性种子（RSL），1项研究随后进行皮肤纹身并使用锝进行放射性引导隐匿性病变定位（ROLL）。除两项研究（143例患者）采用括弧技术外，大多数研究在肿瘤中心使用单一标记物。切缘不满意（阳性/接近）发生率为5%至23.5%。排除完全病理缓解的患者后，“调整后的不满意切缘”率为19.3%（10.4 - 33%）。每1000患者年随访中总体报告局部区域/远处复发20.6例。仅一项研究报告了总体生存率（OS），标记物放置组和未放置组患者的OS分别为96.6%和84.7%（P = 0.01）。再切除率和二次乳房切除术率（9项研究报告）分别为7.3%和5.7%。新辅助化疗前进行肿瘤标记可改善NACT后接受BCS患者的切缘不满意率或生存结局，这方面证据有限。
